Saving for a More Secure Future

As health care spending continues
to surge, it is not surprising
that so much attention is being
focused on the cost of prescription drugs.

A recently published federal study
estimates that drug spending grew by
6.5% to reach $213 billion last year, and
that growth will accelerate over the
next decade, driven partly by new
approvals and higher drug use overall. It
also concludes that even though more
blockbuster drugs are due to become
available as generics, generic dispensing
rates are likely to level off, reducing
the potential for further savings.

Of course, rising drug costs should
be a matter for concernbut are they
the biggest problem? For years, studies
have pointed to the massive expense
resulting from the way drugs
are used, rather than what they cost
to buy.

Lyle Bootman, PhD, dean of the
College of Pharmacy at the University of
Arizona and former president of the
American Pharmaceutical Association,
and coresearchers analyzed the cost of
drug-related morbidity and mortality,
including factors such as the additional
care needed in hospitals, long-term care
facilities, and other settings. Dr. Bootman
argues that even a conservative
estimate puts the real annual cost at
$90 billion to $100 billion, and that the
figure could be far higher, at around
$180 billion. In other words, for every
dollar spent on drugs, almost as much
may be spent treating the consequences
of drug misadventures.

Clearly, if we can reduce these problems,
the potential to save money as
well as lives is enormous. This is an
area where we can play a key rolealthough a major obstacle presents
itself. Today, financial incentives in
health care are structured mainly to
drive short-term savings in areas such
as generic use. If those incentives were
restructured to reward approaches that
prevent medication problems, they
could drive much bigger savings than
those achieved by trimming the cost of
individual drugs.

The emerging medication therapy
management programs provide a
glimpse of the possible future. Using
these early programs as examples, payers
could develop incentives that would
reward community pharmacies for
assuming a critical advisory role in the
health care system. This would allow us
to rely more on these services and less
on dwindling prescription reimbursements.
It is also up to us, however, to
show our willingness to participate. By
doing so, we will help ensure a future
that is both more secure and even more
valuable to others.

Mr. Eckel is professor and director ofthe Office of Practice Developmentand Education at the School ofPharmacy, University of NorthCarolina at Chapel Hill.